The Gut in Diabetes: Side Effects of Stomach Problems

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Many people have heard of celiac disease, gastroparesis and pancreatitis. But do you know about SBBO? It stands for “small bowel bacterial overgrowth,” and it’s characterized by a buildup of bacteria in the intestines.

SBBO doesn’t usually show up on its own, but is present as a consequence of a series of other conditions, like gastroparesis, or side effects of diabetes such as gastric neuropathy.   Bacterial overgrowth may be caused by a reduction in the level of acidity in the stomach and/or a loss of the wave-like contraction movements in the small bowel that propel food through the intestine.

Risk Factors

1. Gastroparesis: Usually, the propulsive movement in the small intestine prevents bacteria from clinging to the intestinal walls. Gastroparesis causes the gut’s contents to stagnate, interfering with one of the gastrointestinal tract’s (GI) normal cleansing properties.

2. Using Anti-Acids: Use of anti-acids and proton pump inhibitors such as  Prilosec and Nexium can reduce gastric acid secretion making it more likely that bacteria will survive the stomach environment and move into the small intestine.


Symptoms of SBBO can mimic those of other bowel disorders.  Patients may experience early satiety, nausea, vomiting, secretory diarrhea, weight loss and epigastric pain.

SBBO has the potential to cause significant nutrient deficiencies.  In normal digestion, bile from the gall bladder mixes with dietary fat allowing the fat to be absorbed into the circulation.  The overgrowth of bacteria disrupts this process, preventing the bile and fat from joining together. The unabsorbed fat causes steatorrhea (fatty diarrhea).

When you don’t digest and absorb fat well, you run the risk of fat soluble vitamin deficiencies (A, D, and E) as well possibly developing calcium oxalate kidney stones.

B12 deficiency is also possible since s the vitamin is a food source for the anaerobic bacteria.

How is it diagnosed?

Although not 100 percent diagnostic, the method often used in clinical practice to identify SBBO is the hydrogen breath test.  For this test, you are given an oral carbohydrate load while hooked up to a breath analyzer that captures the amount of hydrogen in your expired breath volume.

Hydrogen gas is released by the metabolism of bacteria in the small bowel. Levels of hydrogen greater than 20 parts per millions indicate the presence of excessive levels of bacteria.   The test is prone to many interfering factors and aspiration of the small bowel contents is considered the most reliable method for identifying SBBO.


Treatment focuses on ameliorating or removing causes of bowel statis and acid reduction as well as the use of broad spectrum anti-biotics to retard bacterial growth.

Nutrition therapy involves lactose restricted diets to relieve gas and bloating symptoms.  The enzymes to digest lactose are often compromised in SBBO.  In addition, fat modifications may be used in those patients with steatorrhea (fat malabsorption) with replacement of vitamin and mineral losses.

Since the symptoms of SBBO mimic may other diseases it is important to see your health care provider for a specific diagnosis and appropriate treatment.

3 Responses to The Gut in Diabetes: Side Effects of Stomach Problems

  1. Donna says:

    Having great difficulty taking metformin. Stomach issues within hours of taking it.
    Notice fatty stool.
    What is an alternative to metformin?
    What kind of foods would help in deterring the side effects, such as diarrhea?
    Fats are an issue as I also do not have a gall bladder ( was removed 13 years ago), and I had a large ( 2cm) very solid kidney stone removed 2 yrs ago.
    Really would like to get off the metformin….casing havoc with the quality and daily routine of my life.

  2. Terry says:

    Try eating papaya fruit. It contains the enzymes you need to digest your food properly., It’s helped me a lot!!

  3. Trupti says:

    my mom is developing same symptoms. doc proscribed some medication along with diabetes medicine. Can any one pls suggest some diet plan for this.

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